Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is an uncommon genodermatosis. The clinical and radiological features of Peutz-Jeghers syndrome are described in a 12-year-old male child. The relevant literature is briefly reviewed.

[Differentialdiagnosis and surgical treatment of the familial intestinal polyposis (author's transl)]

Between 1959 and 1974 we observed 18 patients with familial intestinal polyposis. 4 patients were from one family. Two brothers refused the operation and died 7 respectively 8 years after diagnosis had been made. The typical symptoms, the diagnostic procedure and the therapy are demonstrated. We prefer the proctocolectomy (eventually with the "Kock-Ileostoma"), because we observed a lot of recidivs after ileorectostomy. The prognosis of the familial intestinal polyposis is good, if the operation is performed early (also in cases of carcinomatosis). Only those patients died, who rejected the operation or were operated too late.

An unusual case of Peutz-Jeghers syndrome in an infant

An 11-month-old girl had an unusual history of colocolonic intussusception associated with polyps that prolapsed through the rectum. Several months thereafter, characteristic brownish-black pigment spots of the lips were noted. The histologic appearance of the polyps was consistent with that of the Peutz-Jeghers syndrome. To our knowledge, this is the youngest reported case of symptomatic Peutz-Jeghers syndrome.

Peutz-Jeghers syndrome: its natural course and management

Two hundred and twenty-two patients with Peutz-Jeghers syndrome were ascertained in Japan between 1961 and 1974 through two nationwide surveys, medical literature, and personal examinations. Genetic analysis was made of this group as well as 102 follow-up cases. The average age at diagnosis was 23 in males and 26 in females, with male to female ratio of 1:1.13. Presenting complaints of 170 patients included obstruction (42.8 per cent of patients), abdominal pain (23.4 per cent), rectal bleeding (13.5 per cent), extrusion of polyp (7.2 percent). Diagnosis of 52 patients was based on melanin pigmentation. Intussusception occurred in 46.9 per cent of the patients, most often in the small intestine. Polyps occurred in the stomach in 108 patients (48.6 per cent), small intestine, 142 patients (64 per cent), colon, 118 patients (53.2 per cent) and rectum, 71 patients (32 per cent). Among the 222 patients, cancer was histologically verified in 28. Fifteen early cancers occurred (3 gastric, 8 small intestine, 4 colon), and 11 advanced cancers (3 gastric, 1 small intestine, 6 colon, and 1 both colon and small intestine). Mortality was lower than in patients with familial polyposis coli but higher than in the general population. Conservative surgical management, planned medical follow-up, and the need for a national registration system are stressed.

Generalized melanoses and nonmelanotic pigmentations of the head and neck

The dentist is in a strategic position to evaluate early color changes of the head and neck. Certain oral and perioral changes of pigmentation are amenable to early diagnosis. Systemically acquired generalized melanoses and nonmelanotic color changes should be periodically reviewed by all examining physicians and dentists. The multiple forms of acanthosis nigricans are described, and the triad of Albright's syndrome is compared with the findings of Peutz-Jegher's syndrome, multiple basal cell nevi, neurofibromatosis, and Addison's disease. The spectrums of changes seen in abnormal nonmelanotic pigmentation are reviewed, and the importance of recognition of drug-induced pigmentation is emphasized.